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The breasts are round and filling and soft there is no apparent redness or engorgement. According to Durham it is important to palpate the breasts for signs of engorgement, tenderness, firmness warmth and enlargement (Durham, 2019). After 24 hours, clear yellow colostrum may develop and this is nutritious for baby. As the milk matures, usually within 72-96 hours, the breasts may become heavier and fuller and feel nodular and firm. The breasts need to be properly assessed for any signs of infection (mastitis) such as pain, redness, and warmth.
The fundus is midline to the umbilicus it is firm 1 below the umbilicus. It is important to check the uterus for location, position and tone of the fundus every shift after the first 24 hours after labor. The normal location for the fundus at 24 hours postpartum is midline at or 1 below the umbilicus (Durham, 2019). During her initial assessment at 39.0 weeks gestation her fundus should be located at approximately 39”.
It is important to check the bladder during the first few days after birth because it allows the nurse to assess the patient’s ability to void, a distended bladder may cause deviation of the fundus and an increased risk for hemorrhage. The normal finding should be a soft non distended bladder (Durham, 2019). Educate mom on importance of peri bottle which is used for perineal irrigation.
The bowels are active throughout all 4 quadrants. Important for mom to have bowel movement, or pass flatus post birth before discharge. Bowel sounds should be assessed each shift with the passing of flatus to happen shortly after delivery of the neonate (Durham, 2019). Also, pt will be given stool softener.
The lochia is important in assessment. It is important to assess for lochia (color, amount, and odor) at the same time as the uterus is assessed. Light is described as less than 4 inches with scant being less than 1 inch. Rubra which is expected for the first 3 days should be red and bloody (Durham, 2019) Lochia should have no odor. The amount is also important to monitor.
This pt had no episiotomy needed, and had a smooth vaginal delivery. The Perineum is assessed at the same time as the fundus and lochia using the acronym REEDA (redness, edema, ecchymosis, discharge, approximation of edges or laceration) (Durham, 2019).
Hommen’s sign or DVT, Women are at risk for thromboembolism related to the increase of circulating clotting factors during pregnancy it is for this reason that we assess the lower extremities for venous thrombosis. Assessment of the calves’ groin area for tenderness, edema or sensation of warmth should happen every shift. The expected finding is no tenderness or sensation of warmth (Durham, 2019).
The patient is extremely tired and anxious for baby. She has had previous births and knows what to expect but she is ready to go home. The patient should be assessed for mood frequently and allowed to voice any concerns that may arise. It is also important to address the concerns of other care providers of the child to ensure stress levels are adequately maintained (Durham, 2019).